tbuckley/cabot-search huggingface dataset:
Abstract 14189: Household Income and Trends in 30-day Readmission for Patients With Heart Failure
Authors: Nijat Aliyev, Muhammad Usman Almani, Muhammad Qudrat Ullah, Gregg C Fonarow, Mohammad S Khan, Stephen J Greene
Journal: Circulation (2022)

Introduction: The relationship between household income and trends in 30-day readmission among patients with heart failure (HF) is unknown. Further, whether the hospital readmission reduction program (HRRP) had differential associations with HF readmissions among patients with lower versus higher household income is unclear. Methods: The National Readmission Database (NRD) was examined to identify all admissions among adults with a primary diagnosis of HF who had at least one unplanned readmission within 30 days between 2010-2019. Median household income by patient zip code was assessed as quartiles: low income, middle income, upper-middle income, and high income. Yearly trends in adjusted all-cause 30-day readmission rates were assessed by household income quartile. Adjusted readmission rates were compared for the pre-HRRP period (2010-2012) vs. post-HRRP period (2013-2019). Results: Among 9,020,742 index hospitalizations between 2010-2019, adjusted all-cause 30-day readmission rates increased for patients in low-income (18.8% to 19.0%, P trend &lt;0.001) and middle-income quartiles (17.6% to 17.9%, P trend &lt;0.001), remained similar in the upper-middle income quartile (17.7% to 17.3%, P trend 0.24), and decreased in the high-income quartile (16.8% to 16.4%, P trend 0.039) (Figure, Panel A). Associations between HRRP and average adjusted all-cause readmission varied by income quartile, such that greater increases in readmissions were seen among patients in lower quartiles (p for interaction &lt;0.001). ( Figure, Panel B) . Conclusions: Among patients hospitalized for HF in the US from 2010-2019, adjusted all-cause 30-day readmission rates significantly differed by neighborhood household income, and increased over time for patients in the lowest two quartiles of household income. Since adoption of the HRRP, greatest absolute increases in all-cause readmission have been observed among patients in the lowest quartile of neighborhood household income.
Abstract 13130: Impact of Midregional N-Terminal Pro-Atrial Natriuretic Peptide, Soluble Suppression of Tumorigenicity 2 and Brain Natriuretic Peptide Levels on Heart Rhythm in Persistent Atrial Fibrillation Treated by Electrical Cardioversion: The Biorhythm 2 Study
Authors: Marc Badoz, Guillaume Serzian, Baptiste Favoulet, Jean-Marc SELLAL, Christian de CHILLOU, Gabriel Laurent, Fiona Ecarnot, Bardonnet Karine, Marie France SERONDE, Francois Schiele, Nicolas Meneveau
Journal: Circulation (2022)

Introduction: We assessed the impact of plasma levels of MRproANP, sST2 and BNP on the maintenance of sinus rhythm at one year after a successful electrical cardioversion of atrial fibrillation. Methods: Prospective, multicenter, observational study including patients undergoing electrical cardioversion of persistent AF. MRproANP, sST2 and BNP were measured in peripheral venous blood before cardioversion. Primary endpoint was recurrent AF detected during the 12 month follow-up, defined as ECG showing AF, or any AF episode lasting &gt;30 seconds on 24 hour Holter monitoring. Results: We included 61 patients from 12/2017 to 03/2019. Average was 67.4±7.8 years, 46 were males (75.4%). Sinus rhythm was restored in 51 patients (83.6%). In these 51 patients, plasma concentrations of MRproANP were significantly higher among patients with recurrent AF at 12 months than among those in sinus rhythm (314.45 [210.90-342.50] vs 214.50 [138.97-264.72] pmol/L, p&lt;0.01). There was no difference between groups in terms of sST2 and BNP concentrations. ROC curve analysis identified an MRproANP threshold of 311.5pmol/L as having the best predictive value for recurrent AF at 12 months. By multivariable analysis, MRproANP &gt;311.5 pmol/L was found to be the sole predictor of AF recurrence (odds ratio 13.57; 95% CI, 2.01-91.54), and identified subjects at very high risk of recurrence (positive predictive value=83.3%). Conclusion: Elevated MRproANP level independently predicts recurrent AF, whereas sST2 and BNP levels do not appear to have any prognostic value in assessing the risk of recurrence of AF at one year after successful electrical cardioversion.
Abstract 12837: A Novel Index to Predict Post-Operative Left Atrioventricular Valve Morbidity in Atrioventricular Septal Defects
Authors: Yu-Shan D Tsen, Dale Burkett, Zhaoxing Pan, Michal Schafer, Pei-Ni Jone
Journal: Circulation (2022)

Introduction: Morbidity of the left atrioventricular valve (LAVV) remains the leading indication for reoperation on atrioventricular septal defects (AVSDs). While qualitative 2D and quantitative 3D risk factors have been identified, no quantitative 2D measurement yet exists to predict poor postoperative outcomes. The aim of this study was to evaluate objective measurements of the LAVV and subvalvar apparatus in relation to postoperative outcomes. Methods: A retrospective review was performed on 2D echocardiograms of patients undergoing surgical repair of an AVSD from January 1, 2014 to December 31, 2021. Demographic and perioperative data were collected from the electronic medical record. The hingepoint-to-hingepoint length of the superior, mural and inferior bridging leaflets in early diastole, as well as LAVV chordal length at end-diastole were measured and indexed to body surface area. A poor outcome was defined by significant LAVV regurgitation (moderate or greater), LAVV stenosis (5mmHg or greater), need for second cardiopulmonary bypass run, postoperative ECMO, reoperation, or death. LAVV measurements were compared to composite outcome by Wilcoxon rank sum test. Results: Of 120 patients with adequate perioperative imaging, 47 (39.2%) had a poor outcome. Indexed LAVV chordal length was significantly different between those who experienced a poor outcome and those who did not, with shorter chordal length predictive of a poor outcome. Interestingly, mural leaflet size was not associated with a poor outcome. Conclusions: Indexed LAVV chordal length is a novel measurement shown to predict a poor postoperative outcome in AVSD. Additional analysis is necessary to assess whether short chords are more predictive of LAVV regurgitation or stenosis, and to determine a numeric cut-off of indexed chordal length for predicting poor outcome.
Abstract 12799: Improving Healthcare Quality Through Innovative Training in Implementation Science
Authors: Stacy L Farr, Danielle Olds, John A Spertus, Anne Sales
Journal: Circulation (2022)

Introduction: Despite the rapid accumulation of evidence, translating this evidence into clinical practice is slow and inefficient. A key barrier is limited understanding of implementation science (IS). As part of a regional strategy to improve the value of healthcare, the Healthcare Institute for Innovations in Quality (HI-IQ) built a curriculum and certificate program, Training in Implementation: Actionable Research Approaches (TIARA) to train researchers and providers with skills in IS. Methods: HI-IQ has built a multi-stakeholder consortium, conducted a healthcare needs assessment, and begun regional QI implementation across multiple hospitals. To support regional QI, TIARA 1.0 was developed and launched as a Certificate program from the Frontiers Clinical &amp; Translational Science Institute (CTSI), with online recordings (www.kcqvic.org/trainings/). Results: Participants (n=120) in TIARA 1.0 came from hospitals, payers, health departments, community-based organizations, and academic institutions. Over 60% of participants reported increases in IS expertise after training. Across all IS competencies (n=8), participants increased an average of 3.7 points (Figure 1). These skills are being applied in a regional program to improving transitions in care for heart failure to not only evaluate the outcomes, but also the facilitators and barriers to implementing the evidence. Due to demand for more and expanded training opportunities in IS, both coursework and additional professional training are being developed. Conclusions : There is a significant unmet need to expand skills in IS for those working in real-world quality improvement and clinical care. HI-IQ’s training approach, utilizing online-hybrid delivery, applied content for practitioners, and real-world project-based applications are promising strategies to train practitioners in how to change healthcare and can model a strategy for other regions to consider in improving care.
Abstract 14138: “RAC”ing up the Coronaries: An Underrecognized Echocardiographic Sign
Authors: John L Medamana, Robert S Zhang, Arushi Singh, Alan Vainrib, Muhamed Saric
Journal: Circulation (2022)

Background: Both the retro-aortic anomalous coronary (RAC) and bleb signs are underrecognized echocardiographic findings suggestive of an anomalous left circumflex (LCx) coursing posterior to the aortic root. We present a patient in whom these echocardiographic signs were identified and confirmed on additional imaging. Case Presentation: A 77-year-old male presented with heart failure secondary to severe MR. In the apical 4 chamber (A4C) view, tilting anterior demonstrated the RAC sign, a highly echogenic tubular structure in the retro-aortic region above the mitral valve (panel A). In the parasternal long-axis view, the bleb sign, a round structure next to the aorto-mitral curtain, was identified (panel B). The RAC sign was also seen in the short-axis (SAX) as a tunnel-shaped structure behind the aortic root. This structure also represents an orthogonal view of the “bleb sign” (panel C). An anomalous LCx was suspected and was confirmed on both CTA and coronary angiography (panel D). The patient underwent successful mitral valve replacement. Discussion: The most common coronary anomaly is a LCx artery arising from the right sinus of Valsalva. Traditionally, either coronary angiography or CTA, has been required for diagnosis; however, these tests are expensive and invasive. The bleb and RAC signs must be differentiated from other more common echocardiographic findings. In the A4C view, the RAC sign can be mistaken for the coronary sinus, which is typically a more posterior structure, or for calcifications of the aortic valve, which would move with the valve and would not have internal anechoic components. The bleb sign can be differentiated from an abscess of the mitral-aortic fibrosa by identifying the tubular retro-aortic appearance of the structure in the SAX view. Conclusion: The RAC and bleb signs offer a noninvasive means identifying an anomalous LCx; however, they must be differentiated from other cardiac structures which can mimic their appearance.
Abstract 13620: Different Outcomes Influenced by Physical Frailty: A Comparison Between Women and Men With Heart Failure
Authors: Sara Hays, Christopher S Lee, Mary Roberts Davis, Nandita C Gupta, Shirin O Hiatt, Jonathan Purnell, Kerri Winters, Quin E Denfeld
Journal: Circulation (2022)

Introduction: Physical frailty is strongly related to adverse outcomes in heart failure (HF), including greater adverse clinical event risk and poor quality-of-life. In HF, women are more likely to be physically frail than men, but little is known about how this sex difference affects outcomes. The purpose of this study was to quantify sex differences in the associations between physical frailty and clinical and quality-of-life outcomes in HF. Methods: This was a prospective study of adults with NYHA Functional Class I-IV HF. A formal assessment of physical frailty was performed using the Frailty Phenotype Criteria; scores range from 0-5. Clinical characteristic data specific to the Seattle HF Model score (SHFM) were collected to account for the severity and treatment of HF. Clinical events (all-cause death, emergency room visit, or hospitalization for cardiovascular cause) over 12 months were adjudicated. Health-related quality-of-life was assessed using the Minnesota Living with HF Questionnaire (MLHFQ). Sex-stratified Cox regression analysis was used to examine associations between physical frailty and clinical events. Sex-stratified generalized linear modeling was used to examine associations between physical frailty and MLHFQ scores. Results: The sample (n = 115) was 63.5±15.7 years old, 49% women, and 29% had HF with preserved EF. After adjusting for SHFM scores, continuous physical frailty scores were significantly associated with time to first clinical event among men but not women. Specifically, for every one point increase in physical frailty score, there was a 46% higher risk of experiencing an event among men (HR = 1.46 [1.00, 2.11], p = 0.047) but not women (HR = 1.21 [0.81, 1.81], p = 0.36). After adjusting for SHFM scores, physical frailty was associated with 89% worse MLHFQ scores among women (p = 0.005) but was not significantly associated with MLHFQ scores among men (p = 0.14). Conclusions: This study demonstrates that physical frailty in HF may be predominantly associated with worse clinical event risk among men and worse quality-of-life among women.
Abstract 14313: Improved NYHA Class and KCCQ-12 After Septal Myectomy in Patients With Obstructive Hypertrophic Cardiomyopathy
Authors: Julia Claire Cambron, Lucy Lin, Morris Kim, Lana Rashdan, Sarah Li, Yuanzi Zhao, Kellie Graham, Katherine Fischer, Babak Nazer, Stephen B Heitner, Howard K Song, Ahmad Masri
Journal: Circulation (2022)

Introduction: Patients with obstructive hypertrophic cardiomyopathy (oHCM) frequently present with heart failure symptoms refractory to medical therapy and require septal myectomy (SM). The magnitude of benefit from SM is thought to be better than the recently reported data from EXPLORER-HCM and REDWOOD-HCM trials. We prospectively investigated the association between SM, patient-reported 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) and physician-reported NYHA class in a community-based cohort of oHCM. Hypothesis: SM ± submitral valve repair is associated with improvement in NYHA class and KCCQ-12 but with a varying magnitude of benefit. Methods: We conducted a prospective cohort study of 108 patients with oHCM who underwent SM (48% women, age 59 (45, 67) years). KCCQ-12 and NYHA class were assessed prospectively prior to SM, at 1-3 months post-SM and at 4-12 months post-SM. KCCQ-12 is reported as an additive score. Data are reported as median values (IQR). Results: Pre-SM, LVEF was 70% (65, 75) while resting and Valsalva LVOT gradients were 42 (22, 90) and 87 (53, 119) mm Hg, respectively. Post-SM, median LVEF was 65% (60, 69) with respective resting and Valsalva LVOT gradients of 11 (8, 16) and 16 (11, 28) mm Hg (all p&lt;0.001). NYHA Classes ≥III decreased in prevalence from 71% to 13% to 3% after SM (p&lt;0.001). Pre-SM, KCCQ-12 was 39 (31, 48), which improved to 51 (41, 57) at 1-3 months post-SM and 58 (52, 63) at 4-12 months post-SM (p&lt;0.001). Changes in NYHA Class distribution and KCCQ-12 scoring after SM are shown in Figure 1. Conclusion: SM was associated with significant improvement in KCCQ-12 and NYHA class in a community-based cohort of oHCM. The inability to conduct blinded NYHA class and KCCQ-12 assessment post-SM is a major limitation given EXPLORER-HCM showed 31% placebo effect on NYHA class. Further contemporary comparative studies of SM and cardiac myosin inhibitors are needed.
Abstract 12830: Significant Smoking Reduction and the Risk of Cardiovascular Disease (CVD): Prospective Results From the Framingham Heart Study
Authors: Meredith S Duncan, Matthew S Freiberg, Robert Greevy, Suman Kundu, Svetlana Eden, Vasan S Ramachandran, Hilary A Tindle
Journal: Circulation (2022)

Smoking cessation reduces CVD risk, but whether significant reduction ( &gt; 50%) in cigarettes per day (CPD) decreases CVD risk is unclear. Some prior studies have reported no benefit but are limited by incomplete capture of smoking exposure due to few smoking assessments or short follow-up. We used Framingham Heart Study data to quantify CVD risk benefits of smoking reduction. We included participants attending at least two exams: 3642 Original cohort starting with their fourth exam (1954-1958) and 3582 Offspring cohort starting with their first exam (1971-1975). Participants were free of CVD at baseline and were followed through 2016 for incident CVD. We updated smoking and other variables every 2 (Original) and 4 (Offspring) years, pooling cohorts for analysis. Using extended Cox regression, we compared CVD risk among 4 categories of person-time: current smoking with significant reduction (CPD reduced by &gt; 50%); current smoking without significant reduction (maintained, increased, or reduced by &lt; 50%); former smokers (quit during follow up); and never smokers. Models were adjusted for sex and time-varying covariates (age, CPD, years reduced, pack-years smoked, and other traditional CVD risk factors). Relative to the Offspring, the Original cohort was older (51 vs 44) and had a larger proportion of current smokers (49% vs 36%) but smoked fewer CPD (19 vs 23). During a median follow up of 27 years, 2327 CVD events occurred (4.3% among significant reducers). Compared to current smoking without significant reduction, significant reduction was associated with lower CVD risk (HR [95% CI]: 0.76 [0.58, 0.99]). After excluding smokers who increased CPD, the effect was similar (HR=0.80 [0.60, 1.08] p=0.14). Significant reduction was associated with higher CVD risk compared to quitting smoking (1.57 [1.24, 2.01]) and never smoking (1.45 [1.12, 1.87]). Significant CPD reduction is associated with lower CVD risk compared to current smoking without significant reduction, but with higher CVD risk compared to quitting and never smoking. These findings incorporate extensive lifetime smoking history, including changes in smoking rate, and provide evidence for public health messaging that, while cessation is preferred, smoking reduction may also decrease CVD risk.
Abstract 13827: Performance Characteristics of Natriuretic Peptides in Predicting Invasively Measured Intracardiac Filling Pressures in Patients With Cancer
Authors: Mariya Fatakdawala, Jorge Irizarry-Caro, Atia Amatullah, Akshitha Yarrabothula, Chase Miller, Charles Wanna, Elie Mouhayar, Cezar Iliescu, Nicolas L Palaskas, Anita M Deswal, Efstratios Koutroumpakis
Journal: Circulation (2022)

Introduction: Natriuretic peptides (NP) are routinely used for the diagnosis of heart failure. Studies have suggested higher levels of NP in patients with cancer, possibly driven by cancer associated inflammation. This study aims to assess the performance characteristics of natriuretic peptides in predicting invasively measured elevated intracardiac filling pressures in patients with cancer. Methods: Patients with cancer who underwent a right heart catheterization (RHC) at a tertiary cancer center from 10/2011 to 10/2021 were identified. Demographic characteristics, NP levels and invasive hemodynamic data were abstracted. Pulmonary capillary wedge pressure (PCWP) &gt; 15 mmHg and mean right atrial pressure (mRAP) &gt; 8 mmHg were defined as abnormal. Results: Of 1240 patients who underwent a RHC, 740 had NTproBNP (41%) or BNP levels (23%) available within a median of 1 day (0-3, and 0-4 days, respectively) from the procedure. Of those, 46% were female, 70% were white, median age was 67 years (IQR: 58-74) and median BMI was 25.2 kg/m 2 (17.4-30.3). High PCWP was present in 58% of patients while an additional 15% had high mRAP with normal PCWP (73%). The area under the curve (AUC) of NTproBNP and BNP in predicting high PCWP was 0.626 (95% CI 0.578-0.675) and 0.681 (0.617-0.744), respectively. The AUC of NTproBNP and BNP in predicting high PCWP or high mRAP was 0.603 (0.549-0.657) and 0.690 (0.621-0.759), respectively. At 125 pg/ml, NTproBNP had a sensitivity of 95%, specificity 6%, positive predictive value (PPV) 57%, and negative predictive value (NPV) 48% for high PCWP and a sensitivity of 95%, specificity 9%, PPV of 74%, and NPV 41% for high PCWP or high mRAP. At 100 pg/ml, BNP had a sensitivity of 89%, specificity 25%, PPV 64%, and NPV 60% for high PCWP, and a sensitivity of 88%, specificity 28%, PPV 77%, and NPV 47% for high PCWP or high mRAP. Conclusions: NP at the standard cutoff levels are very sensitive in predicting elevated intracardiac filling pressures in patients with cancer. However, they can be falsely elevated in &gt;70% of cancer patients with normal filling pressures. These caveats need to be considered when utilizing elevated levels of NP in the assessment of patients with cancer and dyspnea and/or edema.
Abstract 13889: Effect of Eicosapentaenoic and Docosahexaenoic Acid Supplementation on Noncalcified Coronary Plaque and Coronary Artery Calcium Score in Subjects With Coronary Artery Disease According to Hypertension Status
Authors: Essa H Hariri, AbdulAziz A Asbeutah, Abdulaziz Malik, Georges Chedid, Francine K Welty
Journal: Circulation (2022)

Introduction: Higher amounts of noncalcified plaque and higher coronary artery calcium (CAC) scores are associated with increased cardiovascular events and mortality. The effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on noncalcified coronary plaque and more advanced calcified plaque as measured by the CAC score according to hypertensive (HTN) status is unknown. Methods: A total of 242 subjects with coronary artery disease (CAD) on statin were randomized to 3.36 g of EPA+DHA or none (control) for 30 months. Coronary plaque composition and CAC scores were measured with computed tomographic coronary angiography at baseline and 30-month follow-up. Results: Mean (SD) age was 63.1 years (7.7); mean (SD) LDL-C: 77.8 mg/dL (27.3) and median [IQR] triglyceride (TG): 117.5 mg/dL [81.3,166.8]. Despite a significantly higher CAC score at baseline in HTN subjects, both HTN and normotensive (NTN) subjects had similar CAC progression over 30 months with no difference between EPA+DHA and control groups (Figure B). NTN subjects on EPA+DHA had a 20.7% reduction in TG level and 36.6% lower neutrophil count, a marker of inflammation, and lack of progression of noncalcified plaque compared to control who had progression (median % change: -7.6 vs 13.2 mm 3 /mm, P=0.008) (Figure A). In contrast, HTN subjects on EPA+DHA and control had progression of noncalcified coronary plaque with no significant difference between the two groups (Figure A) Conclusions: EPA+DHA prevented progression of noncalcified plaque in NTN subjects but not HTN subjects with no effect on more advanced plaque which has calcified in the setting of low LDL-C and TG levels. The benefit of EPA+DHA in CAD patients on statin therapy appears limited to noncalcified coronary plaque in NTN subjects. Whether this benefit is related to more favorable effects on inflammation based on blood pressure status should be examined further.